M.L. Kamra vs Lt. Governor, Director Of ...
2002 Latest Caselaw 2059 Del

JUDGMENT

Anil Dev Singh, J.

1. By this Letters Patent Appeal the appellant challenges the order of the learned Single Judge dated May 1, 2002 in Civil Writ Petition No. 6717/99. By that order the learned Single Judge declined to issue direction to the respondents to reimburse the medical claim of the appellant in connection with his coronary bypass surgery at Indraprastha Apollo Hospital, New Delhi, and consequently dismissed the writ petition. The facts leading to the appeal are as follows:

2. The appellant is employed as a Trained Graduate Teacher in the senior scale at Dau Dayal Arya Vedic Senior Secondary School, Naya Bans, Delhi. The school is an aided school within the meaning of Delhi School Education Act, 1973. On September 17, 1996, the appellant was diagnosed by the G.B. Pant Hospital, Department of Cardiology, New Delhi, as a case of tipple vessel disease (TVD). After the test, on September 19, 1996 he was discharged from the G.B. Pant Hospital as his condition was found to be stable. The discharge summary of the appellant prepared by the hospital, inter alia, revealed as follows-

"xx xx xx

Provisional CAG Report AO 146/80 LVEDP/

LM Osteal 50-60% Stenosis

LAD Proximal 75% Distal 90% Stenosis

Lex After XM 100% Block

RAC Dominent mild Plaquing in mid RCA

LV Angio Normal Contraclity

Condition of Discharge STABLE"

3. As per the investigation report of the aforesaid hospital, early surgical revescularisation was recommended. It is claimed in the writ petition that after a fortnight of his check up at G.B. Pant Hospital the condition of the appellant deteriorated which necessitated a detailed medical check up. He is stated to have been examined by one Dr. M.B. Gupta on October 5, 1996, and Dr. R.C. Bhatia of Swami Dayanand Hospital, Shahdara, Delhi, on October 9, 1996. According to the appellant, Dr. Bhatia advised immediate coronary bypass surgery. The appellant is stated to have made an attempt for seeking an early date for his operation at the All India Institute of Medical Sciences (AIIMS), but he did not succeed. On October 14, 1996, he was rushed to Indraprastha Apollo Hospital by his relatives. The doctors at the Indraprastha Apollo Hospital admitted the appellant as an indoor patient on October 14, 1996 as if was found that he needed an early surgery for his ailment. On October 17, 1996 the appellant was operated upon at the Indraprastha Apollo Hospital for coronary artery bypass grafting. After the operation the appellant was kept in the aforesaid hospital for post operative care for about eight days.

4. On October 25, 1996 the appellant was discharged from the Indraprastha Apollo Hospital. The total expenses for the treatment and operation at Indraprastha Apollo Hospital including bills for medicines came to Rs. 1,30,238.90 which the appellant paid. On January 11, 1997, the appellant asked the respondent for reimbursement of expenses incurred by him in connection with his operation and treatment at Indraprastha Apollo Hospital. On July 27, 1997, the bills were returned to the appellant without any action being taken in regard thereto by Department of Education, Government of NCT of Delhi. The appellant again submitted the bills to the Education Department of the Government of NCT of Delhi on July 29, 1997. The Department of Education rejected the claim of the appellant for reimbursement on August, 9, 1998. The decision was communicated by the Department of Education to Dau Dayal Arya Vedik Senior Secondary School, which in turn transmitted the aforesaid decision to the appellant on August 27, 1998.

5. On September 21, 1999 the appellant sent legal notices to the second respondent-Director of Education, the third respondent-Deputy Director of Education (North), and the fourth respondent-Chairman/Manager, Dau Dayal Arya Vedic Senior Secondary School, asking them to pay a sum of Rs. 1,30,238.90, being the expenditure incurred by the appellant on his treatment at Indraprastha Apollo Hospital. The respondents did not respond to the legal notices sent on behalf of the appellant as a result thereof he filed a writ petition, being CWP No. 6717/99. The learned Single Judge, inter alia, came to the conclusion that Indraprastha Apollo Hospital was not a hospital recognised by the Govt. of NCT of Delhi for treatment of C.G.H.S. beneficiaries for coronary bypass surgery, and consequently rejected the writ petition and claim of the appellant for reimbursement of the amount spend by him on his treatment at Indraprastha Apollo Hospital, New Delhi. Aggrieved by the order passed by the learned Single Judge, the appellant has filed the instant letters patent appeal.

6. We have heard the learned counsel for the parties at some length. It was vehemently argued by the learned counsel for the appellant that Indraprastha Apollo Hospital has been accorded recognition for specialised and general purpose treatment and diagnostic procedure for the C.G.H.S. beneficiaries, and since the appellant was a C.G.H.S. beneficiary he was entitled for being treated at Indraprastha Apollo Hospital. The learned counsel also contended that the appellant was taken to the Indraprastha Apollo Hospital on October 14, 1996 by his relatives in view of the medical emergency which arose due to his recurrent chest pain and dysponea and in view of the fact that he was advised immediate operation. It may be recalled that the AIIMS did not give an early date for operation to the appellant and in the circumstances the appellant had to be rushed to the Indraprastha Apollo Hospital for immediate treatment. It was also canvassed that the appellant has a fundamental right under Article 21 of the Constitution of self preservation and he was entitled to take treatment at a hospital in which he had full faith and confidence.

7. In contrast, the learned counsel for the respondents submitted that the following three private hospitals were recognised for securing coronary bypass surgery in the case of C.G.H.S. beneficiaries in Delhi:-

1. Batra Hospital and Medical Research Centre.

2. Escorts Health Institute and Research Centre.

3. National Heart Institute and Research Centre.

He also submitted that the persons covered by the Central Services (Medical Attendance) Rules can get themselves treated for TVD at the following government hospitals:-

1. Willingdon Hospital, New Delhi.

2. Safdarjung Hospital, New Delhi.

3. The All India Institute of Medical Sciences, New Delhi.

4. G.B. Pant Hospital, New Delhi.

8. In so far as the AIIMs is concerned it was submitted that the same was a referral hospital and in the event of the appellant not wanting his surgery to be performed at G.B. Pant Hospital, etc., he could have got his case referred to the performed at G.B. Pant Hospital, etc., he could have got his case referred to the AIIMS or any of the aforesaid three private hospitals. It was also submitted that there was no emergency, which necessitated immediate admission of the appellant to the Indraprastha Apollo Hospital. It was argued by the learned counsel for the respondents that since the appellant was treated at a hospital which was not recognised for the treatment of TVD, the appellant cannot claim reimbursement of the amount spent by him for coronary bypass surgery and the claim was rightly declined by the Government of NCT of Delhi.

9. We have considered the submissions of the learned counsel for the parties. It appears to us that there was no need for long drawn arguments in the case since the solution of the matter is a simple one.

10. It is the case of the respondents that the appellant could have got himself treated at any of the three private hospitals, namely, Batra Hospital & Medical Research Centre, Escorts Health Institute and Research Centre, and National Heart Institute and Research Centre. It was also not disputed that in case the appellant would have got the surgery performed at any of the aforesaid three hospitals, he would have been reimbursed for the expenses incurred by him for his treatment. This being so, it appears to us that the respondents should have been concerned only with the fact whether or not the appellant got himself operated upon and whether or not he incurred an expenditure of Rs. 1,30,238.90 on his treatment.

11. The respondents do not dispute the fact that the appellant was admitted in the Indraprastha Apollo Hospital for coronary bypass surgery and he paid a sum of Rs. 1,30,238.90 for the operation and medicines. According to the respondents, the appellant could have availed of the facilities at Batra Hospital & Medical Research Centre, Escorts Health Institute and Research Centre, and National Heart Institute and Research Centre for his coronary bypass surgery. Keeping that in view the respondents could have reimbursed the appellant to the extent of allowable expenses for coronary bypass surgery at any of the aforesaid three hospitals. This seems to be a reasonable view as once put into action it will not impose any extra financial burden on the Government of NCT of Delhi, and at the same time it will remove the hardship of the appellant who actually underwent coronary bypass surgery at Indraprastha Apollo Hospital to save and preserve his life.

12. We may also note that it is not claimed by the respondents that the Govt. of NCT of Delhi is holding any shares or financial interests in any of the hospitals, namely, Batra Hospital & Medical Research Centre, Escorts Health Institute and Research Centre, and National Heart Institute and Research Centre. As against this, it is not disputed that the Government of NCT of Delhi is a major shareholder in the Indraprastha Apollo Hospital. Therefore, we fail to appreciate as to why the Government of NCT of Delhi declined the claim of the appellant when he took treatment in the hospital in which the Government of NCT of Delhi has a share and a abiding financial interest.

13. That apart, our attention has been drawn to the Government of India, Ministry of Health and Family Welfare, O.M. No. S11011/16/94-CGHS/Desk-II/CMO(D)/CGHS(P), dated September 18, 1996. This O.M. contains a list of recognised private hospitals/diagnostic centres under C.G.H.S. in Delhi for specialised and general purpose treatment and diagnostic procedure. This OM was in operation when the appellant was operated upon on October 17, 1996. As already noted, as per the stand of the Government of NCT of Delhi, Batra Hospital and Medical Research Centre, Escorts Heart Institute and Research Centre, and National Heart Institute and Research Centre are the ones recognised for coronary bypass surgery. At this stage, it will be appropriate to quote from the aforesaid O.M. to the extent it has a bearing on the subject in question:-

"xx xx xx

Batra Hospital and Medical Research Centre:-

Both specialized and General purpose treatment and diagnostic procedure except MRI, Lithotripsy and Transplantation.

xx xx xx

18. Indraprastha Apollo Hospital:-

Specialized and General purpose treatment and diagnostic procedures.

xx xx xx

23. Escorts Heart Institute & Research Centre:-

Cardiology, Cardiothoracic and Vascular Surgery.

24. National Hearth Institute & Research Centre:-

Cardiology, Cardiothoracic and Vascular Survey.

xx xx xx"

14. According to the O.M., both Batra Hospital and Medical Research Centre and Indraprastha Apollo Hospital are recognised for specialised and general purpose treatment. While in the case of Batra Hospital and Medical Research Centre it is the stand of the respondents that it is recognised for the purpose of coronary bypass surgery, in the case of Indraprastha Apollo Hospital it is stated that it is not so recognised for the said procedure. We do not appreciate this distinction. In case the stand of the Government of NCT of Delhi that Batra Hospital and Medical Research Centre has been accorded recognition for treatment of CGHS beneficiaries for coronary diseases, on the same analogy it has to be held that the CGHS beneficiaries are entitled for treatment at Indraprastha Apollo Hospital for coronary diseases as well since both the hospitals are recognised for specialised and general purpose treatment. If in the case of Batra Hospital and Medical Research Centre specialised and general purpose treatment includes 'coronary bypass surgery', there is no reason why the same expression when used for Indraprastha Apollo Hospital should not be given the same meaning.

15. For the foregoing reasons, we are of the view that the appellant is entitled to reimbursement on account of money spent by him for coronary bypass surgery and medicines at the Indraprastha Apollo Hospital, New Delhi, to the extent of the expenses which he would have incurred for similar treatment at the Escorts Heart Institute and Research Centre not exceeding Rs. 1,30,238.90. We order accordingly. Accordingly, the appeal is allowed and the order of the learned Single Judge is set aside.